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APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor 60-ndh/ffi |JFER Q .2A ?/)(LCZ 7 Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinos (Hard & Soffit Rouoh Ceilings (T-Bar Rough) lVleter Release 1o sn-L)&c 2a 2oo pta/?) Rouqh Service lVleter I FINAL //t 7)'&)/ZC /9 'A)f/o<, otZrT Notes, Remarks, Etc. OWNIi,R BUII,DER DIiI,CARATION I hereby affirnr under penalty of perjury that I anr exempt frum the Contractors' Licerue l-aw for thc following, reason (Sec.7031.5 Busincss and Profcssion Codc): Any City or County which rcquires a pcrmit to construct, altct. itnprove, dcmolish or repair any structure, prior to its Lssuance. atso requires the applicurt for such pernrit to fib a signed staternent that hc or she is licenscd pursuant to thc provisions of thc Contractor's [,icenscd law (Chapter 9. Comrnencing with Scction 7000 of Division 3 of the Business and Professions Code) or that he or she is exempl therefronr and tlre basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). _1. as owncr ol'the property. or my employees with wagcs as thcir sole compensation, willdo the work and the stntcturc is not intendctl or offcrcd for sale (Sec.7H4. Business and Pnrfcssions Code: The Contractor's License I:w does not apply lo an owner of the pruperty who builds or improves there<rn, and wlro does such work himself or lrerself or through his or lter own entployees, providcd that such ilnprovcrncnts arc not intcndcd or ollcrcd for salc. ll. howevcr, tlrc building or improvcrnent is sold within one year of completioq tlrc Owrrcr Builder will lrave the burden of proving that hc or she did not build or improvc the pnrperry for thc purpose of sale). _1, as owner of the propefly, am exclusively contracting with liccnscd contractors to construcl thc project (Scc. 7044. Busincss aruJ Prrolesskrn Code: The Contractor's License Law does not apply to an owner of proprty who builds or improves thereon. and who conuacts for such projccts wilh a Contractor(s) liccnscd pursuant to the Conuactor's License l-aw). _l anr excmpt under Section-, B. & P.C. tbr this reason. I1... ^' W()RK I.:RS' COt\T PENSA'TION DECLAR/rTI0N I hc'rcby afl'irnr under pcnalty of perjury onc of tltc lolkrwing declarations: -l have and will nnintah a Certificate of Consent to Self-lnsure for workers'conryrensation, as provided for by Section 3700 of the Labor Code, for thc grcrformarrcc of the work for which the pcrndt is issucd. $H*;and its 3700 of the Labor Code, for lhe Jrcrfomunce of ZI-)YI l\ lzoPolicy $q-, ccnify that in thc prfornuncc of tlrc work for which this pcrmit is issucd, I shall not enrploy any lrcrson in any manncr so as to become subjcct to the workers' conrpcn.sation laws of California. and agree that if I should beconrc subjcct to thc workers' conrlrnsation provisions of Section 3700 of the Labor Code, I stull, forthwith conrply with those pnrvisions.. WARNING: Failure to secure workers' compensation covcrage is unlawful, and shall subject an employer to criminal penalties and civil {ines up lo one hundred thousand dollars in addition to the cost of danrages as provided for lhe Section 3076 thc intcrcst and attorncy'sb20 I hereby affirrrr under penalty of perjury that I anr licerrsed Chapter 9 (conurrcncing with Section 7m0) of Division 3 of the lJusincss and Professiorrs Code. and rny license is in lull force and effect. License e\o Number: q]T Sb o VI ar CONSTRUCTION LENDING AGENCY I hcrcby al'firm under pcnalty of pcrjury that thcrc is a construction lcnding agency for the pcrlbrmancc of thc work l'or which this pc.rmit is issued (Scc. 3097. Civ. C.). [.cnder's Name: Lrndcr's Address: APPI,ICANT DECI,ARATION I lxrr:by allirnr undcr pnalty of perjury one of thc fillhrwing dcclarations: Dcnnlition Permits-Astrcstos Notification Fcrlcral Rcgulations (Title 40, Part6) -Rcquircd Lcttcr of Notification _l ccrtily that thc fcderal regulations rcgarding asbestos rernoval arc nol applicable to this projcct. ELECTRICAL.INSPECTOR RECORD -201 5 can'ier alxl policy nunrhcr alc: \ ccrtily that I luvc rcad this application md statc tlral lhc ahlvc infornution is corrcct. I State [:ws above rrcntioncd properry for Applicarrt or l'crnritee nunre construction, and